If I have CRDP, why should I enroll in Part D?
Under Federal regulations, Medicare beneficiaries have only 63
days to enroll in creditable coverage or Medicare Part D from the day they are
initially eligible for Part D. Those who
are eligible and do not enroll timely are assessed a lifetime monthly late
enrollment penalty by Medicare.
Creditable coverage is defined as
coverage as good as or better than Medicare Part D. Since CRDP
drug coverage is not deemed as creditable coverage by Medicare, CRDP cardholders who become Medicare
eligible must elect Medicare Part D or creditable coverage. CRDP
cardholders who do not enroll in Medicare Part D timely, may be assessed a
lifetime late enrollment penalty.
Enrolling in Part D may also help to reduce out-of-pocket costs
for medications not currently covered by CRDP. Individuals
who are Medicare eligible and enroll in Medicare Part D helps incur less costs
to CRDP. Lessening the CRDP’s portion of
drug costs helps to expand benefits in the future.
Can I decide not to enroll in Part D at all?
Yes. Enrollment in
Medicare Part D is voluntary if you are enrolled in CRDP. If you are in CRDP and you choose not to
enroll in Part D, CRDP will continue to pay for your medications. However, if
you lose CRDP coverage and need to enroll in Medicare Part D or if you decide
to enroll in Part D later, you may be assessed a higher monthly premium because
CRDP is not considered "creditable coverage."
Did all CRDP cardholders get selected for Part D?
No. CRDP enrolled cardholders into Part D if they were eligible
for Part D coverage and had not yet enrolled in Part D on their own.
Cardholders who have creditable coverage through an employer or retiree plan or
who are enrolled in a Medicare Advantage plan (Medicare HMO) should not have
been enrolled by CRDP into a stand-alone Part D plan. If you are a CRDP
cardholder whose enrollment into a Part D plan negatively affected any other
healthcare coverage that you have, please contact the program at
How do I know if CRDP is enrolling me in Medicare Part D?
If CRDP enrolls you into a Part D plan, you will receive a
letter from the program telling you the name of the Medicare Part D plan that
they have selected for you. If you did not receive a letter, you would not have
been auto-enrolled into a Part D plan by the CRDP.
If you are enrolled in a Medicare Advantage plan (HMO) or have
creditable coverage through your employer-sponsored retiree plan, CRDP will not
enroll you into a stand-alone Part D plan.
In this instance, if you have creditable coverage, it is considered as
good as or better than Medicare and you may remain in that plan instead of
enrolling in Medicare Part D. CRDP
enrolled you in Part D, it would disrupt your health insurance or cause you to
lose coverage completely. If you have either of these coverages, you should
contact your insurance company for further instructions on whether you should
enroll in Part D.
I have not received any letter or other information from CRDP
about how they will work with my Part D plan. Does that mean that I will not
get any help from CRDP with Part D costs?
All Medicare Part D plans are required to coordinate with CRDP
for the purposes of prescription drug claims.
Ultimately, prescriptions for Medicare Part D covered drugs that are
also on the CRDP formulary will result in the lowest out-of-pocket expense at
All Medicare Part D plans are NOT required to coordinate with
CRDP for the purposes of premiums. To
maximize the help received with premiums, each year, CRDP submits premium
assistance agreements to Part D plans in Pennsylvania. Part D plans that meet the requirements of
the Commonwealth subsequently become premium assistance plans. CRDP cardholders enrolled in a Medicare Part
D plan without a premium assistance agreement will be responsible for paying
the monthly Medicare Part D premium or may opt to switch plans any time
throughout the year due to the lack of premium assistance.
If you are a CRDP cardholder enrolled in a Part D plan that is
not a CRDP partner plan, CRDP will provide coverage during any deductible or coverage
gap phases and payment for co-payment differences between the plan and CRDP.
However, CRDP is not able to provide premium payments unless a premium payment
agreement has been made between the non-partner plan and the Commonwealth.
If you would like to switch to a CRDP premium assistance plan in
order to get the most help with your Part D costs, you can contact the program
I had already joined a Part D plan on my own. Will the CRDP help
me with the costs of that coverage?
The CRDP intends to help all cardholders with the costs of Part
D coverage. If the Part D plan you are
enrolled in has a signed agreement with the Commonwealth, the CRDP will be able
to coordinate with that plan and help with the costs of your coverage.
When did CRDP start working with Part D?
CRDP began working with Part D effective October 1, 2006. Using your
Part D identification card along with your CRDP card at the pharmacy will help provide
cardholders with the lowest out-of-pocket expense at the pharmacy.
How will pharmacies know about these changes?
CRDP staff has informed pharmacies about how the CRDP works with
Part D. We continue to share information with the pharmacy network on a regular
I am not currently enrolled in CRDP. If I enroll in the program,
will I be automatically enrolled in Part D?
If you are enrolled in a Part D plan when you enroll in CRDP,
you can stay enrolled in the Part D plan. If it is not a CRDP premium
assistance plan, we may not be able to help with all the Part D costs.
If you are eligible for Medicare and not enrolled in Part D when
you enroll in CRDP, we will not assign you to a Part D plan immediately upon
enrolling in CRDP. CRDP is a State Pharmaceutical
Assistance Program (SPAP). As an SPAP, CRDP cardholders have two enrollment
periods for Medicare Part D - an annual enrollment period and a special
enrollment period. Contact CRDP for more
information at 1-800-225-7223.
Who will pay the Part D premium?
The CRDP Program will pay the Part D premiums for CRDP
cardholders up to the regional benchmark, which is $37.18 in 2018. However,
in order for this to occur, the CRDP must execute agreements with the Part D
plans. If you are enrolled in a plan that is not a premium assistance plan,
then CRDP will not be able to pay towards your monthly Medicare Part D premium
If I am enrolled in Part D, will I still use my CRDP Card?
Yes, show both cards at the pharmacy. This will tell your
pharmacist to bill your Part D plan first, and bill CRDP second. It will also
tell your pharmacist that you are entitled to all of the drugs that are
available under CRDP.
Will my co-payments be higher with CRDP and Medicare Part D?
No. Enrolling in Part D and CRDP will help you receive lower
out-of-pocket expense for drugs not covered by CRDP. In order to maximize your
lowest out-of-pocket expense, present your Part D and CRDP cards to your
pharmacist and make sure that the pharmacy can bill both programs for your
prescription medications. If you are
taking medications that are not covered by the CRDP, you will pay your Part D
plan's co-pay for those drugs. If there is any confusion at your pharmacy, call
the program's toll free number at 1-800-225-7223 while you are at the pharmacy.
Suppose my Part D plan charges lower co-payments than CRDP. What
You will pay the lower co-payments.
Many Part D plans stop their coverage after you reach a certain
dollar limit. This is sometimes called the doughnut hole. How does this work
under Medicare Part D and CRDP?
The CRDP will fill in the gaps, so that you can continue to get
your drugs just as you did under CRDP. However, if you are taking medications
that are not covered by CRDP, then you will be responsible for the full cost of
the medication that is charged to you by your Part D plan during the doughnut
hole period, unless you have other prescription benefits that can be used
during this time.
Suppose my Part D plan does not cover all of the drugs that CRDP
The CRDP program will automatically pay for drugs that your Part
D plan won't cover, so long as these are drugs covered by CRDP.
Can I go to any pharmacy I choose if I am in CRDP and Medicare
No, you must use the pharmacies that are in your Part D plan's
network and participating with CRDP. If
you decide to change pharmacies, check with your new pharmacy to make sure they
participate in your Part D plan and CRDP.
If my Part D plan offers a mail-order service, can I use it?
Yes, but the mail-order pharmacy must participate with CRDP in
order for the program to help pay for your extra copayments. Also, since you
will be ordering a three-month supply of your drug by mail, you will be paying
up to three CRDP copayments at once. For example, a CRDP cardholder would pay
$18 for a 90-day supply of generic medications.
Where can I get a list of the mail-order pharmacies that I can
CRDP cardholders enrolled in Part D use the pharmacies that
participate in the Part D plan's pharmacy network. If your Part D plan offers
mail-order services, the plan has information for you regarding these
pharmacies in their Welcome Kit and enrollment documents.
How did the program decide which Part D plan to enroll me in?
We looked at the drugs that you take that are covered by the
CRDP and tried to match you up with a partner Part D plan that covers those
medications. We also checked to make sure that your pharmacy participates in
Which Part D plans have partnered with CRDP? What are the
premiums for each plan?
2018 Partner Plans
2018 Monthly Premiums
Silverscript Choice Plan
WellCare Classic Plan
Are these the only plans that I can
No, the CRDP has signed agreements with many Part D plans for
2018 that make it easier for the CRDP to coordinate with them and avoid
confusion. Enrolling in one of these plans guarantees that you get the most
help with your Part D plan costs.
Where can I get more information about the Part D plans
available in PA?
Information about premiums, participating pharmacies and covered
drugs for Part D plans operating in Pennsylvania is available by calling
1-800-Medicare (1-800-633-4227 or 1-877-486-2048 (TTY)) or on the web at: www.medicare.gov.
Can I pick a different plan from the one that the program has
chosen for me?
Yes. During the Annual Open
Enrollment Period from October 15 through December 7, Medicare beneficiaries
can enroll, change, or terminate their Part D plan. The CRDP sends its members a notification regarding their personal plan selection before
the start of this period. If you would
like to pick a different partner plan, you should call 1-800-225-7223. If you
want to enroll in a Part D plan that is not one of our partner plans, you should
call Medicare at 1-800-633-4227.
If I am already enrolled in a Part D plan and have been paying
my monthly premiums to the plan, will I still be switched over to the Part D
plan that the CRDP program picked for me?
During the Open Enrollment Period, you will receive a letter from
CRDP if you are already enrolled in Part D.
The letter helps provide the lowest cost partner plan option for you in
the upcoming year. You may remain in
your current plan and are not required to change plans in order to remain in
CRDP. You may continue to receive
premium assistance from CRDP if your plan is on the premium assistance list.
What should I do if I receive a bill from my Part D plan for the
If you are enrolled in one of CRDP's partner plans, no premium
assistance should be billed to you on a monthly basis. Instead, this monthly premium will be billed
to CRDP and paid on your behalf. If you
are enrolled in one of CRDP’s non-partner plans, you may receive up to the
regional benchmark ($37.18 in 2018) towards your monthly Medicare premium
and/or late enrollment penalty. If your
monthly Part D premium and/or late enrollment penalty is over the regional
benchmark, you will be responsible for the difference not reimbursed by CRDP.
The plan can bill a monthly late enrollment penalty if
enrollment was not performed timely into Medicare Part D.
If you receive a bill from your Part D plan that you believe may
not be your responsibility, please contact the Program at 1-800-225-7223.
If I am in a Medicare Advantage plan without prescription drug
coverage, do I have to change plans to enroll in Part D?
If you are in a Medicare Advantage Plan without prescription
drug coverage and you would like to enroll in Part D, you need to contact your
Medicare Advantage Plan to see if they offer a Part D benefit. If they
do, you should enroll through your Medicare Advantage plan in order to minimize
any disruption to your medical care. If you are in CRDP, the program will
pay the Part D premium portion for you as long as the plan has signed a premium
payment agreement with the CRDP.
If your Medicare Advantage Plan does not offer a Part D benefit,
then you may need to join a different Medicare Advantage Plan through a
different company to get Part D. Keep in mind that changing Medicare
Advantage plans may affect your choice of doctors.